Reducing Potentially Preventable Dental Hospitalizations of Young Children: A Community-Level Analysis.

An increasing number of Australians are being admitted to hospitals and day procedure centers to have dental treatment under a dental general anesthetic (DGA). Children younger than 2 y are having DGAs. These operations are costly and, although there have been improvements in safety, are not without risk. Most DGAs in children are to treat dental caries and have been defined as potentially preventable dental hospitalizations (PPDHs). This article reports on an analysis of the impact of access to community water fluoridation (CWF), availability of oral health professionals (OHPs), and socioeconomic status (SES) on PPDHs of 0- to 4-y-olds in 2012-2013 in Victoria, Australia. Data on these variables were obtained at the community (postcode) level. From the negative binomial multivariate analysis, each of the 3 independent variables was independently significantly associated with PPDHs at the postcode level. Children residing in postcodes without CWF on average had 59% higher rates than those with access (incident rate ratio [IRR], 1.59; P < 0.0001), children in postcodes with the lowest level of availability of OHPs had 65% higher rates than those with the highest access (IRR, 1.65; P < 0.0001), and children living in the most disadvantaged SES quintiles had 57% higher rates than children in the most advantaged quintiles (IRR, 1.57; P < 0.0001). There was a stepwise social gradient by SES quintile. In analysis of access to CWF and SES status, children without access to CWF had 86% higher PPDH rates than children with access (IRR, 1.86; P < 0.0001). In summary, no access to CWF, poor availability of OHPs, and lower SES status were independently associated with higher PPDH rates among 0- to 4-y-olds in Victoria at the postcode level. The study highlights the importance of considering 3 interacting factors-access to CWF, access to OHPs, and SES-in efforts to reduce PPDH rates in young children. Knowledge Transfer Statement: Extending access to water fluoridation, increasing the availability of dental services, and raising disadvantaged families' socioeconomic status are each likely to decrease the rate of dental general anesthetics in young children.

Cultural competence skills in a dental curriculum: A review.

This study aimed to analyse and evaluate the extent of transcultural content in the current curricula of the Doctor of Dental Surgery (DDS), Bachelor of Oral Health (BOH) and Master of Nursing Science (MNSc) courses at the University of Melbourne. METHODS: The study was conducted in two phases: a quantitative review and assessment of the current DDS, BOH and MNSc curricula at the University of Melbourne, and interviews with various staff from the University of Melbourne who were responsible for curriculum development for these courses. RESULTS: Staff from the DDS, BOH and MNSc courses concurred on the importance of transcultural skills, the necessity of covering cultural issues relevant to the main ethnic groups in Australia, obstacles faced and the lack of evaluation methods for cultural competency. The nursing curriculum had the most extensive coverage of transcultural content throughout both years of the course (total 71 formal contact hours; mean 36 formal contact hours per year). In contrast, modules on transcultural skills were limited to the first two of the 3-year BOH course (54 hours; 18 hours) and only the first of the 4-year dental curriculum (40 hours; 10 hours). CONCLUSION: The DDS course showed less time devoted to formal teaching of these concepts compared to the nursing and BOH courses despite showing a noticeable improvement from a previous assessment conducted in 2006. It is hoped that the DDS course continues to further increase the transcultural content and find ways to incorporate more transcultural education.

Economic Evaluation of a Pilot School-Based Dental Checkup Program.

The objectives of this study were to perform an economic evaluation of a targeted school-based dental checkup program in northern metropolitan Melbourne, Victoria. A 12-mo retrospective case-control cohort analysis using the decision tree method evaluated the incremental cost-utility and cost-effectiveness ratio (ICUR/ICER) for passive standard care dental services and an outreach pilot intervention completed in 2013. A societal perspective was adopted. A total of 273 children ( n = 273) aged between 3 and 12 y met the inclusion/exclusion criteria: 128 in the standard care group and 145 in the intervention group. The total society costs included health sector costs, patient/family costs, and productivity losses in 2014 Australian dollars. Outcome measures were evaluated using quality-adjusted tooth years (QATY) and the combined deciduous and permanent decayed, missing, and filled teeth prevented (DMFT-prevented). A generic outcome variable was created to determine the impact of the intervention to reach underserved populations based on government concession eligibility (cardholder status). Uncertainties were incorporated using 95% confidence intervals. The mean total society cost per child is $463 and $291 ( P = 0.002), QATY utility difference is 0.283 and 0.293 ( P = 0.937), effectiveness difference is 0.16 and 0.10 ( P = 0.756), and cardholder status is 50.0% and 66.2% ( P = 0.007), respectively, for the standard care and intervention groups. On average per child, there was a cost saving of $172 and improvement of 0.01 QATY, with an additional proportion of 16.2% of cardholder children reached. The calculated ICER was $3,252 per DMFT-prevented. The intervention dominates standard care for QATY and per 1% cardholder reached outcome measures. Our study found the pilot checkup program was largely less costly and more effective compared with the current standard care. Further research is needed to quantify the value of outreach interventions to prevent dental caries development and progression in populations from low socioeconomic status. Knowledge Transfer Statement: The findings of this research demonstrated that an outreach dental program can be less costly and more effective than standard models of dental care. It showed that a school-based dental checkup program is beneficial despite other opinions that dental screening is ineffective as a method to improve public dental health. There is fiscal economic evidence to support broader expansion of similar programs locally and internationally to reduce dental caries for children from low-income families.

The opinions and attitudes of dental school academic staff towards oral healthcare education for older adults.

The term 'oral health care for older adults' has various interpretations, and its meaning is not clear among dental school academic staff. Additionally, there are no theoretical or practical stand-alone courses on oral health care for older adults in Japanese dental schools. To improve oral health care education, we investigated the opinions and attitudes toward oral health care education for older adults among academic staff in dental schools. Data were collected in seven dental schools from May to September 2013 via an online questionnaire survey. Five-hundred-fifty-eight academics (428 male, 130 female) participated (response rate 57%). The average number of years since they had completed a university degree was 20.2 (SD 10.2) years. The majority (Over 90%) of participants perceived that oral health care should be provided in nursing facilities, hospitals, and at home. Its treatments and instructions should include, not only methods of keeping good oral hygiene, but also improvement of oral function such as swallowing training and salivary glands massage. The majority (84.2%) suggested oral health care education should be combined as a one-credit, stand-alone course. Findings indicate that dental academics have an understanding the need for a course in oral health care for older adults. Participants supported the need for further development of education in oral health care for older adults' in Japan, as a separate course on its own right. However there were some different views about content by teaching field. The need for a national core program for teaching oral health care education was suggested.

Australian/New Zealand Bachelor of Oral Health students: sociodemographics and career decisions.

This article describes the sociodemographic profile and factors affecting career decisions of Bachelor of Oral Health (BOH) students in Australia and New Zealand. Data were collected during the 2009 and 2011 academic years via online. A total of 271 students participated. The majority were female (87.8%), single (74.5%) and of Anglo-Saxon background (59.4%), and the average age was 23.7 years. The majority indicated that their fathers had at least secondary school education. The majority (52.8%) decided to study BOH after high school, and of those who commence after high school, 53.7% worked as a dental assistant/auxiliary. Career selection was self-motivated (70.2%) and a career to 'care for and help other people' (59.6%). Most respondents wished to work in a city (59.8%), in both the public and the private sectors (47.2%). This study represents a comprehensive assessment of BOH student profile in Australia and New Zealand. Findings indicate an overall different BOH student profile compared with other oral health profession students in Australia. A significant proportion had previous employment as a dental auxiliary staff and an increasing number of male students. Findings are relevant to educators, recruitment administrators and policy makers in the way the BOH profession is presented as a career option.

Trends of oral health care and dental treatment needs in relation to molar incisor hypomineralisation defects: a study amongst a group of Iraqi schoolchildren.

BACKGROUND: The dynamic properties of molar-incisor-hypomineralisation lesions (MIH) may impact negatively on personal daily oral care resulting in increased treatment needs. AIMS: To describe and compare individual oral health care practices between MIH-affected and non-affected children, to evaluate and compare dental treatment needs between hypomineralised and non-hypomineralised first permanent molars, and to explore the role of reported fluoride exposure in the development of MIH. STUDY DESIGN: A cluster sample of 7-9 year-old Iraqi schoolchildren (823 of 1000 eligible, response rate 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Of these 153 were diagnosed with the defect and were referred to as MIH-affected children. METHODS: Mothers of the participating children were asked to complete an oral health-questionnaire administered at schools. This included questions regarding child's history of dental visits, fluoride intake and the pattern of oral hygiene practices. Assessment of the dental treatment requirements for the first permanent molars was performed in a sample subset drawn from a larger data set of affected children (n=100) having their teeth assessed previously for dental caries status following the International Caries Detection and Assessment System. The sample subset consisted of 130 hypomineralised molars and 270 non-hypomineralised molars. RESULTS: Of the total sample, approximately 71% of parents had taken their children to the dentist at some stage. For the total sample, tooth restoration or extraction was the most likely causes for seeking dental care at the first dental appointment (57.9%). Tap water was the main source of water consumed at home by the majority of children (77.8%). The prevalence of dental caries and tooth restorations was higher in hypomineralised affected molars (78.5%) than in the defect-free molars (33.7%). STATISTICS: MIH-affected children reported significantly higher frequency of seeking dental care than their non-affected counterparts (82.4%, 68.2%; respectively). They were over three times (OR = 3.18) more likely to visit the dentist complaining of pain and were over six times (OR = 6.37) more likely to seek dental care due to tooth sensitivity than their non-affected peers. No significant differences were found between the study groups in terms of tooth brushing and toothpaste history with brushing frequency "once-a-day" was commonly reported in both groups (75.5%). Early exposure to fluoridated water appeared to have a protective effect for MIH (OR=0.38). Affected molars required more than twice the amount of restorative care than unaffected molars. CONCLUSIONS: MIH did not seem to have an impact on the personal daily oral hygiene practices; however, MIH patients were commonly seeking dental consultation and needed care more often to improve their oral health.

Risk factors of hypomineralised second primary molars in a group of Iraqi schoolchildren.

AIM: To investigate risk factor/s involved in the development of hypomineralised second primary molars and to relate the location of the affected tooth in the dental arches with the timing of the illness/condition incidence. STUDY DESIGN: A cluster sample of 1,000, Iraqi 7-9 year-old children were invited to have their second primary molars examined for demarcated hypomineralised lesions. METHODS: Mothers of 823 children completed a questionnaire-based interview regarding pregnancy and childhood systemic health history. In the clinical examination, the buccal, occlusal and lingual/palatal surfaces of the second primary molar were evaluated for demarcated hypomineralisation lesions by visual examination. RESULTS: A response rate of 82.3% was obtained. Of the children examined, 53 (6.6%) had hypomineralisation defects in at least one second primary molar and were considered as the hypomineralised second primary molar-affected group. Of the total affected teeth (n=83), maxillary molars were the teeth most frequently affected by hypomineralisation throughout all developmental stages (69.9%). Demarcated opacities were the most prevalent lesion type (71.0%). Ninety-four percent of subjects diagnosed with demarcated defects reported various medical conditions possibly associated with hypomineralisation compared with 44% for their non-affected counterparts. Peri-natal medical conditions (45.3%) were the most frequently reported followed by pre-natal and post-natal conditions (24.5%, 9.4%; respectively). STATISTICS: Ill health during pregnancy, delivery complications, neonatal complications, acute childhood illness, birth weight and duration of breast feeding were significant potential risk factors (p<0.05). The greater the number of health events reported, the higher was the chance of developing the defect. Children who experienced neonatal complications and whose mothers reported pregnancy and birth problems were approximately six times more likely to have the defect than those whose mothers had delivery complications only (80% vs 14.6%) (p<0.001). Also of those children whose mothers did not report delivery complications, but were breastfed for less than six months, of low birth weight and had history of upper respiratory tract infection, the chance of hypomineralised defects was over four times more likely to happen than in those who did not suffer any of these problems (25.8% vs 6.7%) (p<0.01). No statistically significant association was revealed between the time of the illness/condition occurrence and the location of the tooth in the dental arches. CONCLUSIONS: Children with hypomineralised second primary molars had experienced more medical conditions than their unaffected peers particularly during the peri-natal period. No single factor was identified as a potential cause, leaving the aetiology of the defect unclear.

Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities.

OBJECTIVE: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are commonly dependent on others for their daily oral hygiene care and often display high levels of plaque and calculus. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. The aim of this study was to investigate the ability of a dental hygienist to undertake a dental examination for residents of aged care facilities, devise a periodontal and preventive treatment plan and refer patients appropriately to a dentist. METHODS: A total of 510 residents from 31 Victorian RACFs were examined, with 275 dentate residents included in this study. Between May 2005 and June 2006, residents were examined by a single experienced dental epidemiologist and one of four dental hygienists using a plane mouth mirror and periodontal probe. RESULTS: A total of 510 residents from 31 RACFs had a dental examination from a dentist and one of four dental hygienists. The treatment needs of residents examined were high, with nearly all of the 275 dentate residents requiring preventive and periodontal treatment, and three-quarters requiring referral to a dentist for treatment. There was excellent agreement between the dentist and hygienists regarding the decision to refer residents to a dentist for treatment, with high sensitivity (99.6%) and specificity (82.9%). Only 8.0% of residents were referred by a hygienist to a dentist when the dentist considered that no referral was required. CONCLUSIONS: Dental hygienists have the skills and knowledge necessary for undertaking a dental examination for residents, correctly identifying the majority of residents who require a referral to a dentist. They are capable of formulating appropriate dental hygiene treatment plans for residents of aged care facilities. It is recommended that there should be greater utilization of hygienists in the provision of dental care to residents of aged care facilities, as a safe, efficient and effective use of health resources.

The impact of changing dental needs on cost savings from fluoridation.

BACKGROUND: Although community water fluoridation has been one of the cornerstone strategies for the prevention and control of dental caries, questions are still raised regarding its cost-effectiveness. This study assessed the impact of changing dental needs on the cost savings from community water fluoridation in Australia. METHODS: Net costs were estimated as Costs((programme)) minus Costs((averted caries).) Averted costs were estimated as the product of caries increment in non-fluoridated community, effectiveness of fluoridation and the cost of a carious surface. Modelling considered four age-cohorts: 6-20, 21-45, 46-65 and 66+ years and three time points 1970s, 1980s, and 1990s. Cost of a carious surface was estimated by conventional and complex methods. Real discount rates (4, 7 (base) and 10%) were utilized. RESULTS: With base-case assumptions, the average annual cost savings/person, using Australian dollars at the 2005 level, ranged from $56.41 (1970s) to $17.75 (1990s) (conventional method) and from $249.45 (1970s) to $69.86 (1990s) (complex method). Under worst-case assumptions fluoridation remained cost-effective with cost savings ranging from $24.15 (1970s) to $3.87 (1990s) (conventional method) and $107.85 (1970s) and $24.53 (1990s) (complex method). For 66+ years cohort (1990s) fluoridation did not show a cost saving, but costs/person were marginal. CONCLUSIONS: Community water fluoridation remains a cost-effective preventive measure in Australia.

Regression of post-orthodontic lesions by a remineralizing cream.

Orthodontic patients have an increased risk of white-spot lesion formation. A clinical trial was conducted to test whether, in a post-orthodontic population using fluoride toothpastes and receiving supervised fluoride mouthrinses, more lesions would regress in participants using a remineralizing cream containing casein phosphopeptide- amorphous calcium phosphate compared with a placebo. Forty-five participants (aged 12-18 yrs) with 408 white-spot lesions were recruited, with 23 participants randomized to the remineralizing cream and 22 to the placebo. Product was applied twice daily after fluoride toothpaste use for 12 weeks. Clinical assessments were performed according to ICDAS II criteria. Transitions between examinations were coded as progressing, regressing, or stable. Ninety-two percent of lesions were assessed as code 2 or 3. For these lesions, 31% more had regressed with the remineralizing cream than with the placebo (OR = 2.3, P = 0.04) at 12 weeks. Significantly more post-orthodontic white-spot lesions regressed with the remineralizing cream compared with a placebo over 12 weeks.

Dental caries experience in young Australian Army recruits 2008.

BACKGROUND: Recent studies have shown a substantial decline in caries experience in Australian Army recruits between 1996 and 2002-2003, and in Australian adults between 1987-1988 and 2004-2006. However, studies in children have reported an increasing trend in caries experience between 1998 and 2002. The aim of this study was to investigate caries experience in Australian Army recruits in 2008. METHODS: A cross-sectional study involving 1084 Australian Army recruits was conducted from January to May 2008. Data were obtained from a clinical dental examination with bitewing radiographs, and a questionnaire elicited socio-demographic data and history on lifetime exposure to fluoridated drinking water. RESULTS: Mean DMFT scores were 3.16, 4.08, 5.16 and 7.11 for recruits aged 17-20, 21-25, 26-30 and 31-35 years, respectively. Recruits with a lifetime exposure to fluoridated drinking water had a mean DMFT of 3.02, while recruits with no exposure had a mean DMFT of 3.87. CONCLUSIONS: Caries experience in Australian Army recruits aged 17-25 years increased between 2002-2003 and 2008. Recruits with lifetime exposure to fluoridated drinking water had 25 per cent less caries experience compared with recruits who had no exposure to fluoridated drinking water after adjusting for the effects of age, gender, education and socio-economic status.

Dental service provision in Victorian residential aged care facilities.

BACKGROUND: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are at high risk of developing dental diseases, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Traditionally, dental service provision has been problematic and sporadic for these residents. METHODS: A postal survey of a random sample of Victorian general dentists and Directors of Nursing (DONs) of Victorian RACFs was undertaken in 2006 to ascertain the participation of dentists in the provision of dental care and to identify factors impacting on the organization and provision of dental care for residents. RESULTS: The response rate for dentists was 57.3 per cent, and for DONs 64.4 per cent. Half of the dentists reported that they had provided care to residents of aged care facilities in the past 12 months, and they spent an average of one hour per month providing care. Overall, dentists were concerned with their level of undergraduate education and training in various aspects of dentistry for residents of aged care facilities. DONs reported significant difficulty obtaining adequate dental care for their residents. Common problems identified by both dentists and DONs included a preference for dentists to treat residents in their own practice, dentists not willing to go to RACFs and a lack of portable dental equipment for dentists to use. CONCLUSIONS: There were low levels of interest and participation from Victorian dentists in providing dental care for residents of aged care facilities. Dentists had a strong preference for treating patients at their own practice, and there were a number of significant barriers that appeared to impact on the provision of dental care in RACFs.

The anticariogenic effect of sugar-free gum containing CPP-ACP nanocomplexes on approximal caries determined using digital bitewing radiography.

This study investigated, using digital bitewing radiography, the progression and regression of approximal caries in adolescent subjects chewing a sugar-free gum containing 54 mg CPP-ACP relative to the identical gum without CPP-ACP. 2,720 subjects from 29 schools were randomly assigned to one of the two gums and were instructed to chew their assigned gum for 3 x 10 min/day, with one session supervised on school days, over the 24-month study period. Standardized digital bitewing radiographs were taken at the baseline and 24-month clinical examinations for each subject. The radiographs, scored by a single examiner, were assessed for approximal surface dental caries at both the enamel and dentine level. Surface level transitions were scored using a transition matrix. Caries progression or regression was analysed using proportional-odds ordered logistic regression modelling of the transition scores at the tooth surface level. There was a statistically significant difference in the frequency distributions of the transition scores between the two gum groups (OR = 0.82, p = 0.03). For subjects chewing the CPP-ACP gum the odds of a surface experiencing caries progression were 18% less than those of a surface experiencing caries progression for subjects chewing the control gum. In conclusion, the 54 mg CPP-ACP sugar-free gum significantly slowed progression and enhanced regression of approximal caries relative to a control sugar-free gum in a 24-month clinical trial.

Fluoride and casein phosphopeptide-amorphous calcium phosphate.

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) slows the progression of caries and remineralizes enamel subsurface lesions. The aim of this study was to determine the ability of CPP-ACP to increase the incorporation of fluoride into plaque and to promote enamel remineralization in situ. Randomized, double-blind, cross-over studies involved mouthrinses and dentifrices containing CPP-ACP and fluoride. The mouthrinses were used for 60 sec, three times/day for 5 days, and supragingival plaque was collected and analyzed for F. The dentifrices were rinsed as a water slurry for 60 sec four times/day for 14 days in an in situ model. The addition of 2% CPP-ACP to the 450-ppm-F mouthrinse significantly increased the incorporation of fluoride into plaque. The dentifrice containing 2% CPP-ACP produced a level of remineralization similar to that achieved with a dentifrice containing 2800 ppm F. The dentifrice containing 2% CPP-ACP plus 1100 ppm F was superior to all other formulations.

Fluoride content of still bottled water in Australia.

BACKGROUND: Recently there has been a considerable increase in the consumption of bottled water in Australia. Overseas studies have found the fluoride levels in many bottled waters are well below levels considered optimal for preventing dental caries. This raises the concern that if bottled water is regularly consumed an effective means of preventing dental caries is unavailable. The aim of this study was to determine the fluoride concentration in 10 popular brands of still bottled water currently sold in Australia. METHODS: The fluoride content of water samples were determined using an ion analyser and compared to a fluoride standard. RESULTS: The fluoride concentration of all bottled waters was less than 0.08 ppm. Only three of the 10 brands indicated the fluoride content on their labels. Melbourne reticulated water was found to be fluoridated at 1.02 ppm. CONCLUSIONS: All bottled waters tested contained negligible fluoride which justifies the concern that regular consumption of bottled water may reduce the benefits gained from water fluoridation. It is recommended that all bottled water companies should consider stating their fluoride content on their labels. This will inform consumers and dental care providers of the levels of fluoride in bottled water and allow an informed decision regarding consumption of fluoridated versus non-fluoridated drinking water.

Assessing sealant retention using a Poisson frailty model.

OBJECTIVE: This paper utilises a Poisson frailty regression model with clustering to report on the failure rates of sealants placed and repaired during a three-year follow-up school-based comprehensive preventive programme. BASIC RESEARCH DESIGN: The programme included annual application/reapplication of light-cured fissure sealants in 210 12-year-old subjects over three years. Sealants placed at the commencement of each year of the programme were assessed for retention 12 months later and repair/reapplication was undertaken at that time for those surfaces judged to require it. An application of a Poisson regression model with random effects ("frailties") and clustering was used in this paper to allow for heterogeneity between subjects. Whilst it appears that the direct utilization of frailty models in determining fissure sealant failure rates has not been reported, it is clearly an appropriate use of this statistical method. A total of 1,544 sealants were placed during the study period. Of these, 1,038 (67.2%) were first placements at baseline and 506 (32.8%) were repairs/reapplications. Of these repairs/reapplications, 206 (40.7%) were performed at first year follow-up and 300 (59.3%) at second year follow-up. RESULTS: The Failure Rate Ratios were statistically significantly greater for second molars cf. first molars (FRR=1.33, p=0.008) and for lower molars cf upper molars (FRR=1.32, p<0.001). Failure rate ratios for sealants placed in the distal occlusal pit and fissures cf. mesial occlusal pit and fissures were significantly higher (FRR=1.33, p<0.001). A significant interaction was found for molar type versus pit and fissure site (p=0.009). There was no significant interaction between molar type and arch. CONCLUSIONS: Sealants placed on second molars, those placed on lower molars and those placed on the distal fissure sites have a higher failure rate. As individual tooth sites in the mouth are not independent, any statistical analysis should allow for these associations when assessing sealant retention.

Dental caries experience in Australian Army recruits 2002-2003.

BACKGROUND: Recent data have suggested that the trend of decreasing caries experience in Australian children is slowing with increasing dmft and DMFT scores seen in children. However, there are limited data on dental caries experience in young Australian adults. METHODS: A cross-sectional study of 973 Australian Army recruits was conducted between November 2002 and March 2003. A clinical examination with bitewing radiographs was conducted and a questionnaire was used to elicit socio-demographic information. RESULTS: Mean DMFT scores were 2.43, 3.44, 5.48, 7.02 and 10.77 for subjects aged 17-20, 21-25, 26-30, 31-35 and 36-51 years respectively. Subjects with a lifetime exposure to fluoridated drinking water had a mean DMFT of 2.80 while subjects with no exposure to fluoridated drinking water had a mean DMFT of 3.91. Multivariate Poisson regression found that age, level of educationand lifetime exposure to fluoridated drinking water had a statistically significant effect on caries experience. CONCLUSIONS: It appears that there has been a continual decline in caries experience and prevalence in young Australian adults between 1996 and 2002-2003. Lifetime exposure to fluoridated drinking water conferred an appreciable benefit for subjects in this study compared with subjects with no exposure to fluoridated drinking water.

Remineralization of enamel subsurface lesions in situ by sugar-free lozenges containing casein phosphopeptide-amorphous calcium phosphate.

BACKGROUND: The anticariogenic potential of casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP) has been demonstrated using laboratory, animal and human in situ caries models. The aim of this study was to determine the effect of CPP-ACP incorporation into a sugar-free lozenge (pressed mint tablet) on enamel remineralization in a human in situ model. METHODS: The study utilized a double-blind, randomized, cross-over design with four treatments: (i) a lozenge containing 56.4mg (3 per cent w/w) CPP-ACP; (ii) a lozenge containing 18.8mg (1 per cent w/w) CPP-ACP; (iii) a lozenge not containing CPP-ACP; and (iv) a no lozenge nil-treatment control. Ten subjects wore removable palatal appliances with four, human-enamel, half-slab insets containing subsurface lesions. Lozenges were consumed, without chewing, four times per day for 14 days duration. After each treatment period the enamel slabs were removed, paired with their respective demineralized control, embedded, sectioned and subjected to microradiography and computer-assisted densitometric image analysis to determine the level of remineralization. RESULTS: The incorporation of CPP-ACP into the lozenge significantly increased enamel subsurface lesion remineralization with 18.8 and 56.4mg of CPP-ACP increasing remineralization by 78 and 176 per cent respectively, relative to the control sugarfree lozenge. CONCLUSION: This study demonstrates that lozenges are a suitable vehicle for the delivery of CPP-ACP to promote enamel remineralization.

Acidic diet and dental erosion among athletes.

BACKGROUND: The consumption of acidic foods and drinks is increasing in popularity. The purposes of the present study were to investigate the consumption patterns of acidic foods and drinks among several sport groups and to examine any relationships between consumption patterns and dental erosion. METHODS: A questionnaire of oral health habits, diet and dental health was developed. Thirty-two sports clubs (690 members) of the University of Melbourne participated in a survey. A total of 508 usable questionnaires were received (74.9 per cent response). Descriptive statistics were prepared and logistic regression was used to explore relationships between dental erosion (dependent variable) and the independent variables. RESULTS: Dental erosion was reported by 25.4 per cent of respondents, particularly among athletes of the Martial arts (affecting 37.4 per cent). The consumption of acidic foods and drinks was frequent among most athletes. No significant associations were identified between dental erosion and the frequency of drinking soft drinks or sports drinks. Statistically significant associations were found between dental erosion and age group (p=0.004), frequency of drinking juices (p=0.05), and tooth sensitivity (p=0.001). CONCLUSION: Athletes may be placing themselves unintentionally at risk of dental erosion and dentists could counsel athletes to control and reduce the effect of potentially erosive foods and drinks.

Caries, bitewings, and treatment decisions.

BACKGROUND: The most common adjunct to the visual and tactile clinical examination for dental caries is the bitewing radiograph. The aim of this study was to report on treatment planning decisions made by Victorian dentists when given a range of predetermined radiographic scenarios. METHODS: A postal survey was conducted to obtain data from 550 dentists selected systematically (every fourth dentist) from the register of the Dental Board of Victoria (1996). RESULTS: The survey response rate was 64 per cent. Fifty per cent of responding dentists selected an operative intervention for radiographic lesions confined to enamel. CONCLUSIONS: A review of current dental literature does not support this approach because a large proportion of proximal tooth surfaces that have associated radiolucencies confined to enamel are not cavitated. This study supports the need for continuing education programmes on the management of dental caries; such programmes should follow an evidence-based model.